Healthcare Provider Details

I. General information

NPI: 1053390229
Provider Name (Legal Business Name): CARMEN OLIVERAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARMEN OLIVERAS-CRESPO M.D.

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W FRYE RD
CHANDLER AZ
85224-6282
US

IV. Provider business mailing address

4530 E MUIRWOOD DR STE 105
PHOENIX AZ
85048-7693
US

V. Phone/Fax

Practice location:
  • Phone: 888-393-8674
  • Fax:
Mailing address:
  • Phone: 480-961-2303
  • Fax: 480-961-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36855
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number36855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: